Thursday, October 08, 2009


*First shared via friendster blogs 31 July 2005.

I don’t make an outline of things I write about. I write as I think. I write when I’ve an urge to do so—a need to put an order to the cluttered thoughts in my head. So now I’m at it again. Now, let’s see where this urge takes me. It’s past 10 p.m. now; I had only five hours of sleep yesterday, but my mind won’t give me rest. God, I’ve been like this the past days since I’ve learned I passed ‘this’ exam, which I’m still not at a liberty to talk about.

Four sisters, aged 38, 36, almost 30, and 21. Arlene, Jenia, Princess, and Diana, respectively. With my name in the sequence, you darn well know, of course, what blah I’m talking about. Yep, us: me and my siblings. And yes, you noticed right, we’re all girls.

Have us stand side by side, and those who don’t know us might have no inkling that we’re related. Because, unlike many siblings, our physical similarities are not striking. Our hair types represent a spectrum, from kulot, buhaghag, unat to wavy. We’re also pretty different in built. Butt and front sizes also differ. Hehehe! I should stop blabbering… Attitudes, yes, in that aspect, too—we’re our own person… It would be interesting to ask my mother how she sees each of us.

So who’s the most good looking? In reference to us, that indeed is a very subjective question, which brings me to cite the all-too-familiar adage: beauty is in the eye of the beholder. True. Answers to this question have been very variable among relatives, neighbors, and friends. But then the implicit assumption is that none of us four is unsightly (for lack of a better term, pangit, if you will). And that to me is enough (I’m the darkest kasi, dehado na kagad.).

But ask: who’s the most generous? It’s Ate Arlene. The most thoughtful? Ate Arlene. The social butterfly? She’s the only one among us: Ate Arlene. The best dressed? She again. Most kikay? Of course, she. Wittiest? She. Most loved by people? Must be her.

Proof of these is her very long list of friends, acquaintances, kumares, kumpares, and of course, inaanaks. She’s a natural. People are drawn to her charm. Is she charming? She sure must be for how else has she befriended so many?

Whom did she take after? The luckiest of us four, she took after our mother’s openness and optimism—two elements that easily win friends…

So you think she’s my idol? I don’t know. We’re quite opposite. But I’m truly proud to be related to her by blood. And all these praises come with a purpose. Oh no! I didn’t just give them out for no reason. Hehehe!!! It’s her birthday come 12 midnight (it’s now 11:25 pm). Tomorrow’s August first. It’s Ate’s birthday.

But, well, she is ONE of a kind!

HAPPY BIRTHDAY, ATE!!! We love u!!!

If this haphazardly composed ‘post’ makes someone happy, then I’m thankful for the URGE that got me started typing furiously away on my laptop this late…

Walang Ligawan

The following article, by a stroke of luck, got published in the Youngblood Section of Philippine Daily Inquirer in its Feb 10, 2000 issue. I retyped the piece (as published) so it could hopefully inspire people to fall madly in love--as doing so, I believe, is one of life's most wonderful events!

I submitted this piece with my pen name "Pise," to make it anonymous although some friends and relatives, who knew me by that nickname, guessed that I wrote it.

At the bottom of the article, the following information about me appeared:

Pise, 24, works as a research associate at the University of the Philippines Los Banos while pursuing a master's degree in development communication.


If divorce were legal in this country, chances are our own statistics on divorce would approximate those of the United States. This thought leaves me wondering why, in the face of all the complexities that family life brings, I still cannot shake off my desire to be married.

I come from a broken home. But I was blessed to have a great woman for a mother. After my father deserted us, she picked up the pieces and strove to make us a family again. After some time, she met another man. And when they decided to live together, she brought me along.

I was only five then. My two older sisters stayed on with my lolo and lola, while my stepfather helped my mother raise me and paid for my education. Now, I have a 15-year-old sister by him, and she is the angel in the family.

To the credit of my mother as well as my stepfather and my grandparents, my sisters and I finished school. All of us are now gainfully employed.

The separation of my parents was not as traumatic to me as it was to my sisters. I don't harbor any resentment against my father since I have very few memories of him. One thing I am sure of is that he was good-looking and he welcomed the attention the girls gave him. It still amuses me to dig up from my lola's baul old pictures of him and his girlfriends.

My father took after my lolo, who also could not resist a temptress. My lolo was a soldier, and he had a wife wherever he was assigned, my lola said. And like my father, he had children by other women.

My eldest sister will be turning 33 this year. My father's youngest child is just three years old. If he had remained faithful to my mother, he could have retired by now. Well, I suppose his six other children are now his source of pride and joy.

Still, it's quite sad that he will not be the one to walk me down the aisle when the time comes. I think it's proper that the one who raised me and sent me to school be the one to give my hand away. When my eldest sister got married, it was lolo who marched with her. We sent father an invitation, but he didn't come.

Let me make it clear that it is not my intention to tarnish my father's name. Our family's history was never a secret. The truth might hurt a little, but we have come to terms with the past and I am happy with the way things turned out for all of us.

What I would like to write about is my fetish for marriage, which is quite strange since I know from experience the risks attached to it. I've been nagging my boyfriend to take me to the altar. And for about two years now, the talk about our wedding has spread like an infection. Wherever I go, people ask, “Is it true? When?” I guess the blame is on me because my standard reply is, “Yes, it will be soon.”

But I give that answer only to stop any further inquiries. It's hard to find excuses for why we still have not settled on a date.

The truth is, it's not only the date that my boyfriend and I are still trying to agree upon. There are a multitude of other details we have to thresh out.

He wants a simple wedding with only a selected few in attendance, I want all those who would like to come to be invited. He wants to hold the wedding in some faraway province to discourage guests from coming, I want everyone to celebrate with us.

He has other weird ideas, but I think he is just using them to send me one message: “Wait a minute, girl. I am not ready yet!” He insists that we should tell our guests to come in very casual wear (read: jeans and shirts), reasoning that he hates formal weddings where guests need to dress up and watch their manners. He says he wants everyone to feel happy and at ease during the wedding.

But his craziest idea yet is to indicate in our wedding invitation that we do not expect gifts, but instead, we will be charging an entrance fee for the reception. To me, that's a surefire formula to to turn our would-be guests away. It is enough to make me cry whenever we discuss our wedding plans. So it is not surprising that while there has been much talk about our engagement, we have no definite plans until this time.

My boyfriend and I had an unconventional courtship. We were in the same batch in college and took the same course. At first, we were not even civil to each other. I thought he was too arrogant, but I had to admit that he was charming. He did not seem to notice that I existed and so I also did not take much notice of him.

Then after our graduation, circumstances forced us to be together. Our work took us to many provinces in Luzon. During the long trips we had to make, we would engage in casual chats while stuck together in a van for hours on end, and often ended exchanging barbs.

After the trips, he would, in his own unique style of storytelling, tell Kleng and Marlon (who happened to be my “sis” and “brod,” respectively, in a college organization) how much he hated me but would later admit he could not deny that I was affecting him. In my case, after spending several days and nights with him, I discovered with great surprise that he was a good and intelligent person. My disgust slowly melted and a deep admiration took its place.

Then one day, while our officemates, Alvin and Locel, were doing a survey in a distant province, I was left in the office with him. He asked me out after work. The timing was perfect as I could no longer contain the feelings I had been suppressing for months.

We went out and after gulping down a bottle of beer and a glass of margarita, I was instantly consumed by the alcohol, and the floodgates were opened. So there I was confessing how much I hated him for not showing any interest in me. I was gesticulating wildly while I told him everything. The sight of me acting drunk caught the attention of the bar owner who decided to come to our table with a cup of coffee, free of charge, to sober me up. But it was not the coffee that made me sober (I did not even touch it), it was the embarrassment. So we left the place in a hurry and went to a playing field in a nearby school campus.

It was his turn to make a revelation. He said he was afraid to admit that he was falling for me but since I had already told him my feelings, there was no point in keeping his own to himself. We sat on a bench for several hours, telling each other about all the things that were important to us, including our families.

That eventful night of August 12, 1996 became the official date of our anniversary. We felt that it would be ridiculous to go through the process of ligawan as we aleady knew what the answer would be. Thus for a long time, our friends in the office had no idea that we were already going steady. I could not let them know since that did not even see him court me.

After that night, I knew in my heart that he was the one for me. I felt how good God could really be. I was not expecting such a beautiful blessing, He gave it to me unexpectedly. Amid all the chaos in the world, life is full of wonderful surprises.

I have been in this heady state of being in love for about four years now. And each day I thank God for entrusting me to a man I know I will one day marry. Meeting him changed my perspective on marriage. I have no worries about what lies ahead. I trust him completely. He makes me want to grab the future and build my own family as soon as possible.

I know my boyfriend is still hesitating to take the plunge, but I know that he wants to do it as much as I do. And now that everyone we know will start anticipating our wedding on account of this article, he might just be finally convinced to take me for his wife.


*Originally posted in July 2005 via an old blog.

Oh, no! Here goes the country again. It’s once again caught in a situation where the powers-that-be couldn’t help but show their true colors. It makes me puke hearing some of our high officials call for PGMA’s resignation. Supreme sacrifice on the part of GMA they say? What of them? They all should be sacrificed to whatever gods would take them so that we could start anew.

I believe that unless we endeavor to wipe out the current political system altogether including those in it (not only PGMA for that matter), we won’t ever have a batting chance of being reformed as a nation. You see, it’s in the very recesses of our system where lie dishonesty, corruption, moral degeneration and all you could think of that characterize traditional Philippine politics.

Sadly, it is in this time of crisis that many wish they were somewhere else but in their homeland. Too bad for the Philippines. But could you blame people who want to leave? Not that they don’t love their country. It’s just that maybe they couldn’t stomach what’s happening to our political system anymore. And since they don’t have powers to change things, living amidst this chaos just becomes more and more frustrating each day.

With the economy receiving the most severe blows owing to this political hullabaloo, we couldn’t prevent our countrymen from seeking for a peaceful and an economically stable place far away from home. I, who (unlike many) prefer to live here (because I love it here despite of the “kahirapan ng buhay”), am now kind of entertaining thoughts of migrating to another country, say, Canada. Could you blame me?

I love my country, mind you! I joined EDSA 2, took to the streets, shouted with all my might the demonstrators’ chant, “Patalsikin si Erap, sobra nang pahirap,” hoping that I could be of help somehow, a voice in the chorus to make the people’s pleas ring louder: curb corruption, at least alleviate poverty (I am reasonable enough to believe that eradicating it would remain wishful thinking in this generation.), and see some good governance really shape up the bureaucracy.

Now, I have lost interest. Who would replace the incumbent? Trapo, you suggest, as in traditional politicians in the likes of Pimentel? Well, haven’t we realized by now that traditional politics is hopeless?! I’d rather stick it out with Gloria. She might have cheated alright, but, who did not? They’re all the same, all wear just one color… Look deeper and you’d find that they’re of one skin, one mind, one goal… I am totally irked, frustrated, mad!!!

Well, still, I pay my taxes… I abide by the law… You couldn’t ask for more, could you? Nah, don’t ask me to join the rallies. I’m not interested anymore. Am tired of rallies which just make our economy sink further...

But, hey, I don’t wish for my personal feelings/thoughts to rub off on you. I don’t want you to be disinterested. It’s important that you frame your own stand and plan your own action. Yes, it still counts; you still count as a citizen. You owe it to the country to do your part in pulling her out of the mess she’s in.

Don’t leave her in this state. I’m just going through a phase. I love her, the Philippines, I mean. Maybe, I am just disgusted with how things are now that I choose not to be involved. Well, just for now… Maybe because I have yet to hear a truly viable solution, one that’s aimed pointedly at effecting true changes in the system, the core of which should be the unseating and non-election of traditional politicians.

Who knows? If I get to talk to (or hear more of) Prof. Randy David, I’m sure I’d turn 360 degrees from my present state of indifference and “bahala na” attitude.


Note: Reposted from my friendster blog; originally posted June, 2005.

Career or family? Which would you choose? This spells dilemma when you’ve just started a family at about the same time that your career is perking up with more attractive opportunities. If you’re a woman, weighing the pros and cons tends to tip the scale in favor of family matters. Unfair it may seem, but I think that it just simply is the natural order of things—the woman takes care of the house while the man earns a living.

So, where does that leave me? Am I breaking any biblical tenet here, wanting to have a career aside from that of being a wife and a mother? Am I making a mistake of trying to balance the scale somehow?

Now, why am I pondering these things? Why am I throwing these questions at you? Why am I boring you with my problems? Nothing, really. I merely want to think and write my thoughts while I’m at it. It’s because I’m now almost 30, and I feel that my professional growth has been stunted somehow in my present occupation. I’ve this nagging desire to explore my options while there’s time.

The wisdom I always call upon in sorting things in my mind is that your children would inevitably be independent, capable of doing things for themselves on their own. Your role as a mother would ultimately just be limited to providing guidance. A child will eventually outgrow his constant need for your presence. And when that time comes, what would keep you busy? Could you spend so many hours day in and day out doing routine chores in the house? That scenario is exactly my greatest fear.

That’s why I chose to maintain a job after giving birth. But, now that my firstborn is almost three years old, rather than having another baby, I feel like focusing on finding that career which is a snug fit to my skills, a career I could grow old having…

I want to raise a family but I also want to build a career… A dilemma. But choosing both might be the wise decision. What do you think?


*Shared June 2005 via friendster blogs; photos have just been added.

I’ve been itching wanting to write something about my mother maybe because I can’t tell her directly how much I love her. I’m not sure why. Maybe it’s my ego. I guess we were just not raised in an environment where being expressive is commonplace, as my mother herself is not demonstrative physically.

Let me tell you more about Nanay. Her parents were both farmers. Theirs was a typical large family in the barrio. Born second in a brood of nine, she took care of her younger siblings. She grew up in a barrio without electricity. She must have been a dreamer as a girl. She knew that nothing would happen to her life if she stayed on in their province. At that time, unlike many young girls who were easily enticed to marrying young boys from their locale just after entering puberty, my mother was wiser and more practical. She went away to find work in another place.

My beautiful mother back in the late '70s.

She met my father while she was living with some relatives in Laguna. I can’t say that marrying my father was a good decision on her part. But, marrying my father was again proof of her sensibility, as my father is an educated man. She finished high school supported by my father and she already had my eldest sister tugging at her skirt when she received her diploma. She also earned some units in college. I don’t know the chronology of events that led to my mother’s working in Manila, while my sisters were left in the care of my grandparents (parents of my father). I was still too young (around four years old then) to comprehend the problems my family was going through.

Pinning a riboon on Ate Jen at her elementary school.

I still have recollections of myself, seated on the steps going up to our small house, waiting for Nanay to come home each day. She took me with her when she decided to reside in Manila. We would come to Laguna every weekend so she could see to my other sisters' needs like washing their clothes. Nanay was practically my world then. I still could remember being scared when she would leave me behind, fearing that something bad might happen to her and she wouldn’t come back. Nanay was my safety then.

Growing up, I’d often hurt myself from riding my bike or from making a run to win a point in games children of my time were fond of playing (patintero, agawan base and the likes). Nanay would carefully treat my wound, and when it hurt real badly that I couldn’t suppress crying, she would also cry seeing me in pain. When the electricity was out, Nanay would patiently fan us while we slept. When I complained about having sore legs from too much playing, Nanay would knead them until they didn’t hurt as much. She would even peel off the shells of quail eggs and boiled peanuts, which I would buy while on the bus going to Manila from Laguna. These things, small they might seem, are etched in my mind. They remind me of one of God’s greatest blessings—that of having my mother.

During my kindergarten field trip.

At a girl scouts' activity. I was in 2nd grade.
At my elementary graduation with my mother standing beside Sen. Nikki Coseteng who donated the medals. Nanay was always dressed well. She is the original fashionista whom my daughter Gabee takes after. :-)

According to my husband, meeting my mother convinced him all the more of his intentions for me when we were still going steady. He thought that being my mother’s daughter, I would naturally take after her traits. Unfortunately, my traits are more often the opposite of my mother’s. I’m cautious and I tend to be pessimistic; Nanay is very optimistic. She takes life one day at a time. She’s pretty much flexible whereas I’m quite rigid about procedures and doing things the right way. She doesn’t have the patience for budgeting but she knows how to raise money when needed (“madiskarte”).

I am too organized compared to her; I keep count of my expenses. Each of my expenses is entered into my excel spreadsheets which I update regularly. I have quite an orderly filing of my receipts, doctors’ prescriptions, and important documents, while Nanay has her records scattered all over the house.

But, if there’s one thing I would like to attribute to her, it would be that of having a good heart. Her nephews and nieces, who came to Manila for their college education, could vouch for her kindness and generosity. She was their “Kakang Belen” they would go to when they were short of money to enroll or when their parents in the province were unable to send their allowances on time, or when they were into any mishaps.

She raised us not in a typical manner whereby a parent tells his/her child what’s good and what’s not, what should be done and what should not be done. I couldn’t remember any instance that she told me to do a particular thing because it was right. Her style was more of the free-wheeling type. She let us decide for ourselves and take responsibility for our actions. I also couldn’t remember being spanked or shouted at by her. (Well, maybe at one time or another, she must have spanked me or shouted at me, but those times must have been very rare as I couldn’t recall them anymore).

I guess Nanay raised us doing what was right, not telling us what was right. And by her example, we naturally developed into what we have become—mature, responsible adults. No one among her four daughters (myself included) gave her a cause for any heartbreak whatsoever. How could we?

I love you, Nay!!! Thanks for everything! I hope I’d be able to raise my children the way you have raised me, Ate Arlene, Ate Jen and Diane.

At Universal Studios Singapore, 2010.

Farewell, UPLB

Note: Reposted from my friendster blog, originally posted in Dec., 2005

This is really “it.” I’ve turned in my resignation yesterday. And this morning, I got a surprise call on my cell phone from the University Chancellor himself asking me about it. Well, he just happens to be the new Chancellor, I guess. Just several months back, prior to his appointment, I gave his name as a reference in my failed application at CIP (it’s not important that I spell that out). And he wrote a very nice recommendation letter for me. He even gave me a copy when he saw me one time at his office. I was flattered. And although I did not get the post I applied for, it was a consolation that people like him saw me in the way that he did. Sad that I’ll be leaving the university I’ve been with the last eight and a half years now that he’s just assumed office. Well, it’s already sad that I’m leaving to start with, but to leave at this particular time makes it a tad more saddening.

I am going around the campus now to have my clearance sheet signed by various offices. My resignation will take effect 31 December. Not that I’m too eager to be out of this place; I just want all things prepared ahead of time to avoid any last-minute fuss.

University of the Philippines Los BaƱos (UPLB). My home. I first saw light here in 1975. I was brought to Manila when I was four years old, came back in 1990, went away again for a year. Then, started my college here in 1992. Got my first job here. Had a chance to leave and work in Manila but preferred to come back. Fell in love and eventually got married here. Had our wedding at the National Arts Centre in Mt. Makiling. Gave birth to my son at the Los Banos Doctors Hospital. Essentially then, I have spent half of my life here.

Now, a new job is going to take me to Manila once more. For the meantime, we will keep our apartment here. Whereas, now I could jump out of bed as late as 7:30 in the morning and still be in office at 8:15, come January I’d have to wake up no later than 5:00 a.m. and be out of the house at 5:30 a.m. I might probably get home at 8 p.m. if I leave Manila at 5:30 p.m. These are among a number of trade-offs I’d have to live with for an entry-level local staff position in a multi-lateral organization in Ortigas.

I’m all excited. Yes, the pay, plus the benefits, is one big factor for my leaving UPLB for another organization. Change in work environment is another. The opportunity for career advancement may be another, although I prefer to take things one at a time for now.

UPLB remains in my heart as an ideal place to settle in. Opportunities are just too limited for the many professionals who have chosen to reside here. Professional competition is tough. In fact, a Ph.D. degree in this scientific community has already become ordinary. A faculty cannot be given tenure unless he’s obtained his doctorate degree. I guess, my place is just not here, profession-wise, mainly because I am not a faculty member. I’m no research scientist either. And getting a Ph.D. is the last thing on my mind right now after completing my master’s just last April.

So to UPLB, many thanks… For the quality education and professional training. For the nice and many intellectually challenging people. For the gifts of nature that have calmed my soul on many occasions. For the feeling of safety I could not feel anywhere else. For that sense of familiarity with everything here. My heart is yours. My life has been shaped by momentous events that you have been witness to. You shall be my resting place when my time comes… I’ll be back to stay forever…

Graduating with a master's degree in development communication from UPLB.

With fellow development communication graduates.

Getting There--To The End Of My Journey--This Time Around

Day 0, Tuesday, 15 Sep
Armed with the guarantee of payment from my insurance, I got myself admitted to Mount Elizabeth Hospital. A friendly Filipino, named Rod, seated me, asked for my passport, and checked the room reservations list. He said a single room was booked for me by my doctor’s clinic. He looked up my file and then went away for a while. Coming back, he had his own copy of the letter from my company’s insurance and a one-pager estimate of the hospitalization costs, excluding doctors’ fees, as he pointed out. I glossed it over, I was sure it was going to be taken care of by the insurance, except for lodger fees which were on top of the cost of a single room.

In a short while, we were escorted to Ward 6. Two nurses helped me settle in, one of whom was Irene, a Filipina. My husband, Let, and I marveled at the room appointments. It was huge, carpeted, with a new-looking Hill-Rom hospital bed and a huge sofa bed. The room was one grade lower than what I was entitled to, making us wonder what the single deluxe room looked like.

After settling in, a pathology staff came and took 4 tabs of blood. Afterwards, I went for the pre-surgery tests such as chest X-Ray and ECG.

Day One, Wednesday, 16 Sep
I was offered a sleeping pill the night before the surgery in case I was too tensed to sleep. But I did manage to doze off without taking the drug. It was a repeat surgery after all, and the operation, as explained by the neurosurgeon, would be simpler than the first one I had—no cut on the inner mouth would be done as he would only access the pituitary gland through my nostrils.

The operation was set for 9:30am. By three quarters past 9, an Indian lady fetched me from my room. When she came in, I asked why it was rather early, but she dismissed my question and asked me to change into the hospital gown. I did so, taking my time as I reluctantly got into the oversized blue gown which ties at the back. By this time, I was feeling a bit nervous. Good thing there was no chance to drum up my anxiety as I was fetched early. I got into the wheelchair, and glanced up to Let. Now, he was the one looking more worried as all he could muster was “Bye.” and “Kita na lang.” (See you.), as I was being wheeled out of the room.

I was then made to wait beside another patient in a stretcher in the waiting room near the Operating Theater, OT, (that’s how they call the OR). An Indian nurse came over with my folder and asked the usual pre-operation questions. Like the other Indian nurses who attended to me while I was in the ward, this one also appeared aggressive as she stood at the foot of the stretcher, leaning over my feet quite heavily and jotting down my responses.

Five minutes to nine, I was fetched by the anesthetist, a lady doctor in her fifties but with an air of youth around her, and was wheeled into the OT. She helped curb my tension as she tried to strike up a small chat asking me of what I do in the Philippines, and what the political situation was back home. I smiled at her when she asked me whether I was rooting for Aquino (Noynoy). “There is so much possibility to do good,” she said. I agreed. This exchange happened as she was inserting the drip. In the meantime, my neurosurgeon had all the scans up on the white screen and the big machine fixed on me. Then, in a snap I went out.

Four and a half hours later, I woke up to a headache inside the Critical Care Unit (CCU or ICU as it’s more commonly called). I was still very drowsy but managed to listen to the anesthetist as she relayed me the good news that they saw the tumor and Dr. Ho, the neurosurgeon, was able to remove it. I said, “Thank you.” I was still feeling heady from the drugs—anaesthesia and morphine. I have a faint memory of talking briefly to Dr. Ho, hearing him tell me that he believed that he had cured me. And then I sensed Dr. Peter Eng, my endocrinologist, hovering around me, giving instructions to the nurse. The nurse then inserted a catheter.

I again drowsed off, and woke up half past 5pm looking for my husband. The nurse called him in from the waiting area. I was already fully awake. Let came in, grasped my right hand, and gently kissed it. It was a beautiful moment. I felt God’s hand over us. It was too good, too beautiful to awaken to a loved one whose eyes showed so much gratefulness. I was happy. It was my birthday. And I was truly happy notwithstanding the physical pain from the surgery.

After a while, Dr. Ho entered the room to officially break to us the good news. He said that the operation was successful but it took more than 4 hours, as it took him 2 hours to get in and locate where my pituitary gland was. He explained that the scar from the previous operation modified how my pituitary anatomy looked, making it difficult to say which was which. According to him, he almost gave up and would have abandoned the operation if he still was not able decipher on which part the tumor was excised.

After 2 hours, he finally located the scar from a very small opening through which my first neurosurgeon accessed the gland. Once inside, he related that he then found a yellowish tissue on the right distinct from the normal gland which had a pinkish hue. Further, there was a suspicious-looking mass on the left side, which he also removed.

Dr. Ho has done quite a number of transphenoidal surgeries. He explained to me, during my first consult at his clinic, that he chooses to be more aggressive in his methods as he would rather excise a part of the normal gland than risk having a residual tumor missing his curettes. Apart from the normal procedure of scraping the tumor, he uses 100% alcohol to ensure that he kills all the undesirable tissue around the gland—a procedure not done by other neurosurgeons, but which, he said, works well for his patients based on his observation.

Dr. Ho is already in his 60s. But, to me, he looks much younger than his age, appearing still in the prime of health. He has a very good command of English, and is able to explain in great detail the procedure, mentioning his experience with patients with the same case. He mentioned that he had a patient, who happened to be a medical doctor as well, who was diagnosed with acromegaly based solely on his blood chemistry as there was no evident tumor that could be found on his MRI scans. The second time that he performed the operation on this doctor-patient of his, he was also at a loss in identifying which was the pituitary gland, and rather than create more damage, he closed him up, and abandoned the operation. He had to be aided by an MRI imaging the third time around. Needless to say, the operation was successful and the doctor, he said, so far is doing well in remission.

Day Two, Thursday, 17 Sep
Thanks to the morphine drip, I managed to get some sleep in the CCU. I had Leonie, a Filipina nurse attend to me from 10 pm to 8 am. She closely monitored my BP as the machine would frequently alarm when it dipped to around 85/45.

At 8am, Leonie endorsed my case to Furong, an equally competent and caring Chinese nurse. Furong offered me fish congee, Milo, and orange juice for breakfast. The doctor said I could eat anything. But I had no appetite. The surgery had temporarily affected my sense of smell, hence, making even the most delicious foods taste bland.

Dr. Eng, my endocrinologist, came and looked at my stats. I asked if my BP was alright. He said it was okay as my BP had always been on the low end, and the surgery had caused it to drop a bit. He ordered for hydrocortisone (cortisol/steroid) injections explaining that it is commonly given after a pituitary surgery to aid the body in recovering. I was also given Panadol (Paracetamol). He ordered for the morphine drip to be stopped. I was okay, the headache I had was mild.

Furong then arranged for my transfer to the ward. After securing a room, she removed my catheter, unhooked me from the monitors, put me in a wheel chair, and brought me to Ward 10 (Royal/Exec. Suites). I was surprised to learn that all single deluxe rooms were housed amongst the suites which accommodate the royalty and big personalities. I also did not realize that this would later on put me in a battle with the hospital’s billing dept. which would refuse to be convinced that my insurance was going to cover my “deluxe” accommodation.

Day Three, Friday, 18 Sep
Dr. Ho came early, and without any ado, motioned for the nurse to assist him as he pulled out the nasal packing. Out it went in a snap! Some blood dripped. The nurse plastered on some gauze to my nose to catch the dripping blood. I thought I’d be able to finally breathe through my nose again! But alas, my nose was heavy with mucous. I could somehow breathe from the left opening but the right side was totally blocked.

During the night, sleep would not come. The sleeplessness I would experience in the next days had then started. I could not doze off without a sleeping tablet. No matter what position I took, no matter how tired and drowsy I felt I was, I just could not completely snooze!

Day Four, Saturday, 19 Sep
I was feeling better except for the blocked nose. I was no longer getting a headache. And I was enjoying the food being served by the butler although I could hardly taste it. Yep, the room accommodation made for a royal hospital stay. There was a butler on call!

Drs. Ho and Eng visited me twice everyday, once in the morning and again in the afternoon. I felt I was feeling good enough to be discharged. But, they noticed that I was peeing more. The nurses had been keeping count of my fluid input and output as diabetes insipidus, manifested by uncontrolled urination, was a common complication secondary to a pituitary surgery.

Dr. Ho was going away for the long weekend. It was going to be a public holiday Monday, 21 September, in Singapore to celebrate the end of Ramadan. He said that from his point of view, there was not going to be any more major complication. He ruled out any CSF (cerebrospinal fluid) leak. He said that he thought I was okay for discharge, but just to be sure, he recommended that I consume the 7-day guaranteed confinement issued by my insurance. He then said that he would leave my case to his neurosurgeon colleague, Dr. Alvin Hong. I thanked Dr. Ho, remarking that he had been great and agreed to see him at his clinic after I was discharged.

Day 5, Sunday, 20 Sep
I was walking about by this time and spending less time in bed. I was trying to tire myself hoping I could sleep unaided by the tablet.

I was starting to dread the nightfall as I imagined hours of turning in bed, finding no position that would make me get a full rest.

I was also peeing more, but Dr. Hong, the reliever, said that I was still okay and they wanted my brain to adjust naturally, hence, they were not giving me any medicine.

Day 6, Monday, 21 Sep
The day passed pretty much the same as the last one. Things had become a routine by this time. Let and I would Skype to see our kids online. I ached to go home.

Day 7, Tuesday, 22 Sep
The pathology staff came by 8am, and hourly afterwards until 10am to take blood samples for the hormone and liver function tests. I was given a glucose drink at 0 hour to check for growth hormone suppression.
At last I was going to be discharged! Dr. Eng gave me some take-home meds—Panadol for headache ad Imovaine for sleeplessness.

I was excited. I was still kind of weak, my nose was as blocked as it was from day 2, but I felt I was ready to get out of the hospital.

Let and I checked in to 2-star hotel. Hotel rates had doubled because of the Formula 1 (Grand Prix) event happening in SG on 24-26 Sep.

Day 8, Wednesday, 23 Sep
We went to see Drs. Eng and Ho at their clinics. Dr. Ho showed us the lab results. Gist of which was that we had attained the targeted growth hormone suppression level of less than 1 mIU/L. And although still rather early, my insulin growth factor (IGF 1) level was down from 352 to 212 ug/L. All other hormones (e.g., FSH, LH, and cortisol) remained within the normal ranges, meaning I had no need for any hormone replacement therapy. Thanks to Dr. Ho who did the job so cleanly yet thoroughly.

My growth hormone results (mIU/L) were:
• Pre-surgery, 15 Sep: 4.29
• Random, 0 hr: 0.70
• 1 hr: 0.23
• 2 hr: 0.96

Dr. Eng was sure that Dr. Ho would be happy to also see the results of the hormone tests. He said that IGF-1 test could be repeated after 2 months to get a more stable and accurate result. But, as for growth hormone, he is confident that we attained the clinically acceptable results for ascertaining that “cure” has been achieved. Symptomatically, soft tissue swelling around my fingers and toes had receded. It could also be that the water I previously retained was lost after my growth hormone levels went down.

Dr. Ho, for his part, showed us the histopathology report confirming that the tissues removed consisted of pituitary adenoma (tumor) which was growth-hormone secreting. He showed us a picture of the specimen. Dr. Ho was happy with the results. He repeated what he told me at the CCU that he thinks that he has cured me. He explained again how the operation went, and patiently answered our questions. We thanked him immensely and arranged to stay in contact by email for my next consultation.

After the consults with Drs. Eng and Ho, Let and I visited a high school friend of mine at their place in Choa Chu Kang, near East Jurong. We had dinner. I was full.

We were back at the hotel past 10pm. I was tired but again I could not sleep. I got up around 1am feeling nauseous. Then I started vomiting heavily. Afterwards, I took the sleeping pill to get some rest.

Day 9, Thursday, 24 Sep
I felt worse in the morning. I vomited again although I had practically nothing to throw up except water. I felt so weak that I asked Let to get me quickly to the hospital. Let phoned Dr. Ho and was instructed to bring me to the ER.

Dr. Ho came shortly after we arrived. My blood sample was taken for analysis. He confirmed with me first that what I was only vomiting, and that there was no fluid leaking from my nose. He then called Dr. Eng. I overheard him telling Dr. Eng that I could be having Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Seeing how weak I was, Dr. Ho decided to have me re-admitted. I was again back at the ward.

I felt terrible, lethargic, spinning. The nurse injected something into the hep-lock for the dizziness. Dr. Eng came with the lab result. My sodium was at 120 mmol/l, normal is from 135-150 mmol/l. It was normal upon my discharge at 139, but suddenly dropped after 1 day causing the vomiting and dizziness.

He ordered me to restrict my fluid intake to a maximum of 800 ml per 24 hours. He also instructed treatment with i/v 3% saline 150 ml over 6 hours.

Day 10, Friday, 25 Sep
I felt that this time around was even more difficult. The saline drip was quite painful. The nurse had to reinsert the i/v line twice, making me have 4 insertions in total!

I realized that headache is far more pleasant than dizziness. I felt out of control whenever I was feeling dizzy.

Dr. Eng explained that I had a bit of diabetes insipidus (DI) 3 days after the operation. I then went on to have SIADH. My pituitary had been damaged a bit causing it to produce less ADH during the DI phase and then more ADH afterwards.

My brain, according to Dr. Ho, got a bit confused. The good thing was that it meant that ADH was not in short supply. And for a time, it was signaling my body to conserve water, resulting in salt dilution.

Day 11, Saturday, 26 Sep
We were scheduled to fly back to Manila at 5:40 pm. I was still nauseous upon waking up. I vomited again. But I resolved to be discharged. I managed to take a shower despite feeling giddy. I wanted to go home badly by now.

I was counting on the assurance of Dr. Eng that my sodium level would definitely come up so long as I was restricting my fluid intake.

Dr. Eng came early, and shortly after, Dr. Ho also arrived. They discussed my case and agreed that they expected nothing else to crop up. Because if there was any other complication, it would have manifested itself by this time, i.e., 10 days post-operation. They were confident that I was okay for discharge even if the sodium level had not yet normalized. It somehow stabilized at 119 mmol/l. Dr. Eng again assured me that it would normalize in 2 days.

By 1pm, we were off to Changi Airport. We were still rather early for our flight to Manila with ETD of 1740. Typhoon Ketsana, with local name “Ondoy,” was then inundating Manila. I was kept updated by posts made on Facebook. Rains had been non-stop since last night and floods were fast engulfing low-lying areas in Manila including our place, Taytay. Our Cebu Pacific flight was delayed as the aircraft was stalled by bad weather conditions in Manila. We finally boarded past 10pm, after long hours of waiting.

Day 12, Sunday, 27 Sep
We arrived NAIA half hour past 1am. I was feeling nauseous again so I asked for a wheelchair. We got out of the airport 2:30am and reached Ortigas by 3am. All roads to Cainta and Taytay were inaccessible. Trucks blocked the highway. Some parts of Ortigas Extension were flooded waist-deep. We were stranded!

It had been a very long wait at the airport. Now, there was nothing we could do but wait again until the floods subside and the roads clear. I had to spend the night in a hotel. Let had to leave me alone to fly to Cebu that night and report for work the following day. Good thing that my sister, who works in Laguna, was near the area as she was also stranded. She came to the hotel to accompany me. I was still feeling weak. It was likely that my sodium level was still low.

It was an ordeal alright. But I could not complain. I had no right to complain seeing the devastation brought on by the typhoon to the victims. The flooding was a nightmare! It made for good fiction. But seeing it claim lives and destroy so many homes was too much, making my recent experience pale in comparison to the kind of trial Ondoy suddenly brought to many Filipinos.

I am awed with gratitude. Our place, though right between Cainta and Taytay which were two of the most badly hit municipalities by Ondoy, was spared. I finally reached home the following day, 28 Sep, straight into the arms of my two children. I was home safe and cured. I have everything to thank God for.

with Dr. Ho Kee Hang - neurosurgeon

with Dr. Peter Eng - endocrinologist

with a Filipina nurse at Ward 10

taken at the lobby of Mount Elizabeth Hospital during my first discharge, 22 Sep 2009

Sunday, September 20, 2009

Winner in God's Amazing Grace

Acromegaly is a rare medical condition. I’m one case in 3-4 of a million cases happening per year. Yep, that rare! Maybe because in most cases the disease is left undiagnosed until it manifests major complicating conditions, like diabetes and cardiovascular problems, which are then treated as the primary ailments.

Wikipedia better explains this rare disease:

Most pituitary tumors arise spontaneously and are not genetically inherited. Many pituitary tumors arise from a genetic alteration in a single pituitary cell which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but is acquired during life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells; it permanently switches on the signal that tells the cell to divide and secrete growth hormones. The events within the cell that cause disordered pituitary cell growth and growth hormone oversecretion currently are the subject of intensive research.

I faced it head-on 1 Feb 2007 when I went in for surgery in Manila. The tumor that showed in my first MRI scans measured around 7mm. This was reduced post operation to a subtle 3mm. Between that time and last 16th of Sep, that subtle residual tumor had been insidiously affecting my life on the whole. I know I was not yet cured. I know the battle had not ended. And I know that there was still something that could be done. Something within my reach. Something that just needed me to will it to happen.

And on 16 Sep 2009, with one of the best neurosurgeons in Singapore, something amazing happened. I went under the knife (again) with a faith enough to ride any tide. It was an extraordinary day. For one, it was my 34th birthday. It was the 2nd time I was taking my chances of battling it out with an unheard of disease amongst my circles of family and friends. A post on Facebook before midnight immediately drew attention to my status, and all through the next day, messages poured in. The prayers whispered to God by family, relatives and friends from all around were truly amazing. Not only did they make me feel loved, they made me come out of the surgery cured. Yes, I have the gut feel, and the faith that I have defeated acromegaly finally. I have a whole life, maybe another 34 years, may be even more to look forward to. I can now happily picture myself in Gabee’s 18th birthday, Garrett’s college graduation, in both their weddings, and in many happy family occasions yet to happen.